|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT 21933
|
| Hospital Charge Code |
21933
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$769.23 |
| Max. Negotiated Rate |
$1,098.90 |
| Rate for Payer: Priority Health SBD |
$769.23
|
| Rate for Payer: Aetna Commercial |
$1,037.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.65
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cofinity Advantage |
$854.70
|
| Rate for Payer: Cofinity Commercial |
$1,050.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$976.80
|
| Rate for Payer: Healthscope Commercial |
$1,098.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.75
|
| Rate for Payer: PHP Commercial |
$1,037.85
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT 21933
|
| Hospital Charge Code |
21933
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$769.23 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Commercial |
$1,037.85
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,977.11
|
| Rate for Payer: BCN Commercial |
$1,977.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cofinity Advantage |
$854.70
|
| Rate for Payer: Cofinity Commercial |
$1,050.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$976.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$1,098.90
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.85
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.75
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$1,037.85
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$769.23
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,075.00
|
|
|
Service Code
|
HCPCS 21932
|
| Min. Negotiated Rate |
$400.01 |
| Max. Negotiated Rate |
$1,556.25 |
| Rate for Payer: Aetna Commercial |
$826.43
|
| Rate for Payer: Aetna Medicare |
$641.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.11
|
| Rate for Payer: BCBS Complete |
$420.01
|
| Rate for Payer: BCBS MAPPO |
$616.74
|
| Rate for Payer: BCN Commercial |
$1,009.41
|
| Rate for Payer: BCN Medicare Advantage |
$616.74
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cofinity Commercial |
$888.11
|
| Rate for Payer: Cofinity Commercial |
$826.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.74
|
| Rate for Payer: Healthscope Commercial |
$986.78
|
| Rate for Payer: Healthscope Commercial |
$1,140.97
|
| Rate for Payer: Mclaren Medicaid |
$400.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.58
|
| Rate for Payer: Meridian Medicaid |
$420.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$678.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,186.00
|
| Rate for Payer: Nomi Health Commercial |
$740.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,556.25
|
| Rate for Payer: PACE SWMI |
$616.74
|
| Rate for Payer: PHP Medicare Advantage |
$616.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,079.02
|
| Rate for Payer: Priority Health Medicare |
$616.74
|
| Rate for Payer: Priority Health SBD |
$1,079.02
|
| Rate for Payer: Priority Health Tiered Network |
$1,079.02
|
| Rate for Payer: Railroad Medicare Medicare |
$616.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,165.90
|
| Rate for Payer: UHC Core |
$1,165.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$616.74
|
| Rate for Payer: UHC Exchange |
$1,165.90
|
| Rate for Payer: UHC Medicaid |
$400.01
|
| Rate for Payer: UHCCP Medicaid |
$400.01
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 21014
|
| Min. Negotiated Rate |
$306.29 |
| Max. Negotiated Rate |
$923.85 |
| Rate for Payer: Aetna Commercial |
$627.44
|
| Rate for Payer: Aetna Medicare |
$486.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.27
|
| Rate for Payer: BCBS Complete |
$321.60
|
| Rate for Payer: BCBS MAPPO |
$468.24
|
| Rate for Payer: BCN Commercial |
$791.29
|
| Rate for Payer: BCN Medicare Advantage |
$468.24
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cofinity Commercial |
$674.27
|
| Rate for Payer: Cofinity Commercial |
$627.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.24
|
| Rate for Payer: Healthscope Commercial |
$866.24
|
| Rate for Payer: Healthscope Commercial |
$749.18
|
| Rate for Payer: Mclaren Medicaid |
$306.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$491.65
|
| Rate for Payer: Meridian Medicaid |
$321.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$515.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.85
|
| Rate for Payer: Nomi Health Commercial |
$561.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$681.75
|
| Rate for Payer: PACE SWMI |
$468.24
|
| Rate for Payer: PHP Medicare Advantage |
$468.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$306.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$845.88
|
| Rate for Payer: Priority Health Medicare |
$468.24
|
| Rate for Payer: Priority Health SBD |
$845.88
|
| Rate for Payer: Priority Health Tiered Network |
$845.88
|
| Rate for Payer: Railroad Medicare Medicare |
$468.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$906.73
|
| Rate for Payer: UHC Core |
$906.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$468.24
|
| Rate for Payer: UHC Exchange |
$906.73
|
| Rate for Payer: UHC Medicaid |
$306.29
|
| Rate for Payer: UHCCP Medicaid |
$306.29
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 21013
|
| Min. Negotiated Rate |
$237.07 |
| Max. Negotiated Rate |
$721.50 |
| Rate for Payer: PHP Medicare Advantage |
$361.82
|
| Rate for Payer: Aetna Commercial |
$484.84
|
| Rate for Payer: Aetna Medicare |
$376.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.02
|
| Rate for Payer: BCBS Complete |
$248.92
|
| Rate for Payer: BCBS MAPPO |
$361.82
|
| Rate for Payer: BCN Commercial |
$609.03
|
| Rate for Payer: BCN Medicare Advantage |
$361.82
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cofinity Commercial |
$521.02
|
| Rate for Payer: Cofinity Commercial |
$484.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.82
|
| Rate for Payer: Healthscope Commercial |
$669.37
|
| Rate for Payer: Healthscope Commercial |
$578.91
|
| Rate for Payer: Mclaren Medicaid |
$237.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$379.91
|
| Rate for Payer: Meridian Medicaid |
$248.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$398.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$710.91
|
| Rate for Payer: Nomi Health Commercial |
$434.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$721.50
|
| Rate for Payer: PACE SWMI |
$361.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.04
|
| Rate for Payer: Priority Health Medicare |
$361.82
|
| Rate for Payer: Priority Health SBD |
$651.04
|
| Rate for Payer: Priority Health Tiered Network |
$651.04
|
| Rate for Payer: Railroad Medicare Medicare |
$361.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.75
|
| Rate for Payer: UHC Core |
$696.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$361.82
|
| Rate for Payer: UHC Exchange |
$696.75
|
| Rate for Payer: UHC Medicaid |
$237.07
|
| Rate for Payer: UHCCP Medicaid |
$237.07
|
|
|
PR EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
HCPCS 25071
|
| Min. Negotiated Rate |
$257.94 |
| Max. Negotiated Rate |
$1,244.25 |
| Rate for Payer: Aetna Commercial |
$529.66
|
| Rate for Payer: Aetna Medicare |
$411.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$529.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.19
|
| Rate for Payer: BCBS Complete |
$270.84
|
| Rate for Payer: BCBS MAPPO |
$395.27
|
| Rate for Payer: BCN Commercial |
$648.38
|
| Rate for Payer: BCN Medicare Advantage |
$395.27
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cofinity Commercial |
$569.19
|
| Rate for Payer: Cofinity Commercial |
$529.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.27
|
| Rate for Payer: Healthscope Commercial |
$731.25
|
| Rate for Payer: Healthscope Commercial |
$632.43
|
| Rate for Payer: Mclaren Medicaid |
$257.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.03
|
| Rate for Payer: Meridian Medicaid |
$270.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$434.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.38
|
| Rate for Payer: Nomi Health Commercial |
$474.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,244.25
|
| Rate for Payer: PACE SWMI |
$395.27
|
| Rate for Payer: PHP Medicare Advantage |
$395.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$257.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$693.09
|
| Rate for Payer: Priority Health Medicare |
$395.27
|
| Rate for Payer: Priority Health SBD |
$693.09
|
| Rate for Payer: Priority Health Tiered Network |
$693.09
|
| Rate for Payer: Railroad Medicare Medicare |
$395.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$742.01
|
| Rate for Payer: UHC Core |
$742.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$395.27
|
| Rate for Payer: UHC Exchange |
$742.01
|
| Rate for Payer: UHC Medicaid |
$257.94
|
| Rate for Payer: UHCCP Medicaid |
$257.94
|
|
|
PR EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 25076
|
| Min. Negotiated Rate |
$313.11 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$638.85
|
| Rate for Payer: Aetna Medicare |
$495.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.52
|
| Rate for Payer: BCBS Complete |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$476.75
|
| Rate for Payer: BCN Commercial |
$797.27
|
| Rate for Payer: BCN Medicare Advantage |
$476.75
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$686.52
|
| Rate for Payer: Cofinity Commercial |
$638.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.75
|
| Rate for Payer: Healthscope Commercial |
$881.99
|
| Rate for Payer: Healthscope Commercial |
$762.80
|
| Rate for Payer: Mclaren Medicaid |
$313.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$500.59
|
| Rate for Payer: Meridian Medicaid |
$328.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$524.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$921.89
|
| Rate for Payer: Nomi Health Commercial |
$572.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE SWMI |
$476.75
|
| Rate for Payer: PHP Medicare Advantage |
$476.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$852.26
|
| Rate for Payer: Priority Health Medicare |
$476.75
|
| Rate for Payer: Priority Health SBD |
$852.26
|
| Rate for Payer: Priority Health Tiered Network |
$852.26
|
| Rate for Payer: Railroad Medicare Medicare |
$476.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$899.27
|
| Rate for Payer: UHC Core |
$899.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$476.75
|
| Rate for Payer: UHC Exchange |
$899.27
|
| Rate for Payer: UHC Medicaid |
$313.11
|
| Rate for Payer: UHCCP Medicaid |
$313.11
|
|
|
PR EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM
|
Professional
|
Both
|
$1,786.00
|
|
|
Service Code
|
HCPCS 21556
|
| Hospital Charge Code |
21556
|
| Min. Negotiated Rate |
$313.32 |
| Max. Negotiated Rate |
$1,339.50 |
| Rate for Payer: Aetna Commercial |
$644.50
|
| Rate for Payer: Aetna Medicare |
$500.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.60
|
| Rate for Payer: BCBS Complete |
$328.99
|
| Rate for Payer: BCBS MAPPO |
$480.97
|
| Rate for Payer: BCN Commercial |
$803.24
|
| Rate for Payer: BCN Medicare Advantage |
$480.97
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cofinity Commercial |
$692.60
|
| Rate for Payer: Cofinity Commercial |
$644.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.97
|
| Rate for Payer: Healthscope Commercial |
$889.79
|
| Rate for Payer: Healthscope Commercial |
$769.55
|
| Rate for Payer: Mclaren Medicaid |
$313.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.02
|
| Rate for Payer: Meridian Medicaid |
$328.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$529.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$943.90
|
| Rate for Payer: Nomi Health Commercial |
$577.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,339.50
|
| Rate for Payer: PACE SWMI |
$480.97
|
| Rate for Payer: PHP Medicare Advantage |
$480.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$858.65
|
| Rate for Payer: Priority Health Medicare |
$480.97
|
| Rate for Payer: Priority Health SBD |
$858.65
|
| Rate for Payer: Priority Health Tiered Network |
$858.65
|
| Rate for Payer: Railroad Medicare Medicare |
$480.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.90
|
| Rate for Payer: UHC Core |
$922.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$480.97
|
| Rate for Payer: UHC Exchange |
$922.90
|
| Rate for Payer: UHC Medicaid |
$313.32
|
| Rate for Payer: UHCCP Medicaid |
$313.32
|
|
|
PR EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM
|
Facility
|
OP
|
$1,786.00
|
|
|
Service Code
|
CPT 21556
|
| Hospital Charge Code |
21556
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,125.18 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Commercial |
$1,518.10
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,160.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.24
|
| Rate for Payer: BCN Commercial |
$1,950.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cofinity Advantage |
$1,250.20
|
| Rate for Payer: Cofinity Commercial |
$1,535.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,428.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$1,607.40
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,518.10
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,339.50
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$1,518.10
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$1,125.18
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
PR EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM
|
Professional
|
Both
|
$1,786.00
|
|
|
Service Code
|
HCPCS 21556
|
| Min. Negotiated Rate |
$313.32 |
| Max. Negotiated Rate |
$1,339.50 |
| Rate for Payer: Aetna Commercial |
$644.50
|
| Rate for Payer: Aetna Medicare |
$500.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.60
|
| Rate for Payer: BCBS Complete |
$328.99
|
| Rate for Payer: BCBS MAPPO |
$480.97
|
| Rate for Payer: BCN Commercial |
$803.24
|
| Rate for Payer: BCN Medicare Advantage |
$480.97
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cofinity Commercial |
$692.60
|
| Rate for Payer: Cofinity Commercial |
$644.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.97
|
| Rate for Payer: Healthscope Commercial |
$889.79
|
| Rate for Payer: Healthscope Commercial |
$769.55
|
| Rate for Payer: Mclaren Medicaid |
$313.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.02
|
| Rate for Payer: Meridian Medicaid |
$328.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$529.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$943.90
|
| Rate for Payer: Nomi Health Commercial |
$577.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,339.50
|
| Rate for Payer: PACE SWMI |
$480.97
|
| Rate for Payer: PHP Medicare Advantage |
$480.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$858.65
|
| Rate for Payer: Priority Health Medicare |
$480.97
|
| Rate for Payer: Priority Health SBD |
$858.65
|
| Rate for Payer: Priority Health Tiered Network |
$858.65
|
| Rate for Payer: Railroad Medicare Medicare |
$480.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.90
|
| Rate for Payer: UHC Core |
$922.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$480.97
|
| Rate for Payer: UHC Exchange |
$922.90
|
| Rate for Payer: UHC Medicaid |
$313.32
|
| Rate for Payer: UHCCP Medicaid |
$313.32
|
|
|
PR EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM
|
Facility
|
IP
|
$1,786.00
|
|
|
Service Code
|
CPT 21556
|
| Hospital Charge Code |
21556
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,125.18 |
| Max. Negotiated Rate |
$1,607.40 |
| Rate for Payer: Aetna Commercial |
$1,518.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,160.90
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cofinity Advantage |
$1,250.20
|
| Rate for Payer: Cofinity Commercial |
$1,535.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,428.80
|
| Rate for Payer: Healthscope Commercial |
$1,607.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,518.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,339.50
|
| Rate for Payer: PHP Commercial |
$1,518.10
|
| Rate for Payer: Priority Health SBD |
$1,125.18
|
|
|
PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Professional
|
Both
|
$1,053.00
|
|
|
Service Code
|
HCPCS 23076
|
| Hospital Charge Code |
23076
|
| Min. Negotiated Rate |
$333.77 |
| Max. Negotiated Rate |
$965.99 |
| Rate for Payer: Aetna Commercial |
$684.20
|
| Rate for Payer: Aetna Medicare |
$531.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.26
|
| Rate for Payer: BCBS Complete |
$350.46
|
| Rate for Payer: BCBS MAPPO |
$510.60
|
| Rate for Payer: BCN Commercial |
$832.63
|
| Rate for Payer: BCN Medicare Advantage |
$510.60
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cofinity Commercial |
$735.26
|
| Rate for Payer: Cofinity Commercial |
$684.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.60
|
| Rate for Payer: Healthscope Commercial |
$944.61
|
| Rate for Payer: Healthscope Commercial |
$816.96
|
| Rate for Payer: Mclaren Medicaid |
$333.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.13
|
| Rate for Payer: Meridian Medicaid |
$350.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$561.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.99
|
| Rate for Payer: Nomi Health Commercial |
$612.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$789.75
|
| Rate for Payer: PACE SWMI |
$510.60
|
| Rate for Payer: PHP Medicare Advantage |
$510.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$890.05
|
| Rate for Payer: Priority Health Medicare |
$510.60
|
| Rate for Payer: Priority Health SBD |
$890.05
|
| Rate for Payer: Priority Health Tiered Network |
$890.05
|
| Rate for Payer: Railroad Medicare Medicare |
$510.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.85
|
| Rate for Payer: UHC Core |
$945.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$510.60
|
| Rate for Payer: UHC Exchange |
$945.85
|
| Rate for Payer: UHC Medicaid |
$333.77
|
| Rate for Payer: UHCCP Medicaid |
$333.77
|
|
|
PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
CPT 23076
|
| Hospital Charge Code |
23076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$663.39 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Commercial |
$895.05
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,180.96
|
| Rate for Payer: BCN Commercial |
$1,180.96
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cofinity Advantage |
$737.10
|
| Rate for Payer: Cofinity Commercial |
$905.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$947.70
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.05
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$789.75
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$895.05
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$663.39
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Professional
|
Both
|
$1,053.00
|
|
|
Service Code
|
HCPCS 23076
|
| Min. Negotiated Rate |
$333.77 |
| Max. Negotiated Rate |
$965.99 |
| Rate for Payer: Aetna Commercial |
$684.20
|
| Rate for Payer: Aetna Medicare |
$531.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.26
|
| Rate for Payer: BCBS Complete |
$350.46
|
| Rate for Payer: BCBS MAPPO |
$510.60
|
| Rate for Payer: BCN Commercial |
$832.63
|
| Rate for Payer: BCN Medicare Advantage |
$510.60
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cofinity Commercial |
$735.26
|
| Rate for Payer: Cofinity Commercial |
$684.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.60
|
| Rate for Payer: Healthscope Commercial |
$944.61
|
| Rate for Payer: Healthscope Commercial |
$816.96
|
| Rate for Payer: Mclaren Medicaid |
$333.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.13
|
| Rate for Payer: Meridian Medicaid |
$350.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$561.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.99
|
| Rate for Payer: Nomi Health Commercial |
$612.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$789.75
|
| Rate for Payer: PACE SWMI |
$510.60
|
| Rate for Payer: PHP Medicare Advantage |
$510.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$890.05
|
| Rate for Payer: Priority Health Medicare |
$510.60
|
| Rate for Payer: Priority Health SBD |
$890.05
|
| Rate for Payer: Priority Health Tiered Network |
$890.05
|
| Rate for Payer: Railroad Medicare Medicare |
$510.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.85
|
| Rate for Payer: UHC Core |
$945.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$510.60
|
| Rate for Payer: UHC Exchange |
$945.85
|
| Rate for Payer: UHC Medicaid |
$333.77
|
| Rate for Payer: UHCCP Medicaid |
$333.77
|
|
|
PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
CPT 23076
|
| Hospital Charge Code |
23076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$663.39 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Aetna Commercial |
$895.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.45
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cofinity Advantage |
$737.10
|
| Rate for Payer: Cofinity Commercial |
$905.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.40
|
| Rate for Payer: Healthscope Commercial |
$947.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$895.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$789.75
|
| Rate for Payer: PHP Commercial |
$895.05
|
| Rate for Payer: Priority Health SBD |
$663.39
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Facility
|
IP
|
$1,196.00
|
|
|
Service Code
|
CPT 22900
|
| Hospital Charge Code |
22900
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$753.48 |
| Max. Negotiated Rate |
$1,076.40 |
| Rate for Payer: Aetna Commercial |
$1,016.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.40
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cofinity Advantage |
$837.20
|
| Rate for Payer: Cofinity Commercial |
$1,028.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.80
|
| Rate for Payer: Healthscope Commercial |
$1,076.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,016.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$897.00
|
| Rate for Payer: PHP Commercial |
$1,016.60
|
| Rate for Payer: Priority Health SBD |
$753.48
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Facility
|
OP
|
$1,196.00
|
|
|
Service Code
|
CPT 22900
|
| Hospital Charge Code |
22900
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$753.48 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Commercial |
$1,016.60
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,180.96
|
| Rate for Payer: BCN Commercial |
$1,180.96
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cofinity Advantage |
$837.20
|
| Rate for Payer: Cofinity Commercial |
$1,028.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$1,076.40
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,016.60
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$897.00
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$1,016.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$753.48
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Professional
|
Both
|
$1,196.00
|
|
|
Service Code
|
HCPCS 22900
|
| Min. Negotiated Rate |
$349.11 |
| Max. Negotiated Rate |
$1,008.49 |
| Rate for Payer: Aetna Commercial |
$720.46
|
| Rate for Payer: Aetna Medicare |
$559.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.23
|
| Rate for Payer: BCBS Complete |
$366.57
|
| Rate for Payer: BCBS MAPPO |
$537.66
|
| Rate for Payer: BCN Commercial |
$861.51
|
| Rate for Payer: BCN Medicare Advantage |
$537.66
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cofinity Commercial |
$774.23
|
| Rate for Payer: Cofinity Commercial |
$720.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.66
|
| Rate for Payer: Healthscope Commercial |
$994.67
|
| Rate for Payer: Healthscope Commercial |
$860.26
|
| Rate for Payer: Mclaren Medicaid |
$349.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.54
|
| Rate for Payer: Meridian Medicaid |
$366.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.49
|
| Rate for Payer: Nomi Health Commercial |
$645.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$897.00
|
| Rate for Payer: PACE SWMI |
$537.66
|
| Rate for Payer: PHP Medicare Advantage |
$537.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$920.92
|
| Rate for Payer: Priority Health Medicare |
$537.66
|
| Rate for Payer: Priority Health SBD |
$920.92
|
| Rate for Payer: Priority Health Tiered Network |
$920.92
|
| Rate for Payer: Railroad Medicare Medicare |
$537.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.79
|
| Rate for Payer: UHC Core |
$990.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.66
|
| Rate for Payer: UHC Exchange |
$990.79
|
| Rate for Payer: UHC Medicaid |
$349.11
|
| Rate for Payer: UHCCP Medicaid |
$349.11
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Professional
|
Both
|
$1,196.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
22900
|
| Min. Negotiated Rate |
$349.11 |
| Max. Negotiated Rate |
$1,008.49 |
| Rate for Payer: Aetna Commercial |
$720.46
|
| Rate for Payer: Aetna Medicare |
$559.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.23
|
| Rate for Payer: BCBS Complete |
$366.57
|
| Rate for Payer: BCBS MAPPO |
$537.66
|
| Rate for Payer: BCN Commercial |
$861.51
|
| Rate for Payer: BCN Medicare Advantage |
$537.66
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cash Price |
$956.80
|
| Rate for Payer: Cofinity Commercial |
$774.23
|
| Rate for Payer: Cofinity Commercial |
$720.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.66
|
| Rate for Payer: Healthscope Commercial |
$994.67
|
| Rate for Payer: Healthscope Commercial |
$860.26
|
| Rate for Payer: Mclaren Medicaid |
$349.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.54
|
| Rate for Payer: Meridian Medicaid |
$366.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$591.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.49
|
| Rate for Payer: Nomi Health Commercial |
$645.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$897.00
|
| Rate for Payer: PACE SWMI |
$537.66
|
| Rate for Payer: PHP Medicare Advantage |
$537.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$920.92
|
| Rate for Payer: Priority Health Medicare |
$537.66
|
| Rate for Payer: Priority Health SBD |
$920.92
|
| Rate for Payer: Priority Health Tiered Network |
$920.92
|
| Rate for Payer: Railroad Medicare Medicare |
$537.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.79
|
| Rate for Payer: UHC Core |
$990.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$537.66
|
| Rate for Payer: UHC Exchange |
$990.79
|
| Rate for Payer: UHC Medicaid |
$349.11
|
| Rate for Payer: UHCCP Medicaid |
$349.11
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>
|
Professional
|
Both
|
$1,239.00
|
|
|
Service Code
|
HCPCS 22901
|
| Min. Negotiated Rate |
$409.17 |
| Max. Negotiated Rate |
$1,189.10 |
| Rate for Payer: Aetna Commercial |
$847.26
|
| Rate for Payer: Aetna Medicare |
$657.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.48
|
| Rate for Payer: BCBS Complete |
$429.63
|
| Rate for Payer: BCBS MAPPO |
$632.28
|
| Rate for Payer: BCN Commercial |
$1,011.40
|
| Rate for Payer: BCN Medicare Advantage |
$632.28
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cofinity Commercial |
$910.48
|
| Rate for Payer: Cofinity Commercial |
$847.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.28
|
| Rate for Payer: Healthscope Commercial |
$1,169.72
|
| Rate for Payer: Healthscope Commercial |
$1,011.65
|
| Rate for Payer: Mclaren Medicaid |
$409.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$663.89
|
| Rate for Payer: Meridian Medicaid |
$429.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$695.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,189.10
|
| Rate for Payer: Nomi Health Commercial |
$758.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.25
|
| Rate for Payer: PACE SWMI |
$632.28
|
| Rate for Payer: PHP Medicare Advantage |
$632.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,081.16
|
| Rate for Payer: Priority Health Medicare |
$632.28
|
| Rate for Payer: Priority Health SBD |
$1,081.16
|
| Rate for Payer: Priority Health Tiered Network |
$1,081.16
|
| Rate for Payer: Railroad Medicare Medicare |
$632.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,178.07
|
| Rate for Payer: UHC Core |
$1,178.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$632.28
|
| Rate for Payer: UHC Exchange |
$1,178.07
|
| Rate for Payer: UHC Medicaid |
$409.17
|
| Rate for Payer: UHCCP Medicaid |
$409.17
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
CPT 22901
|
| Hospital Charge Code |
22901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$780.57 |
| Max. Negotiated Rate |
$1,115.10 |
| Rate for Payer: Aetna Commercial |
$1,053.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.35
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cofinity Advantage |
$867.30
|
| Rate for Payer: Cofinity Commercial |
$1,065.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.20
|
| Rate for Payer: Healthscope Commercial |
$1,115.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.25
|
| Rate for Payer: PHP Commercial |
$1,053.15
|
| Rate for Payer: Priority Health SBD |
$780.57
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
CPT 22901
|
| Hospital Charge Code |
22901
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$780.57 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Commercial |
$1,053.15
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,377.78
|
| Rate for Payer: BCN Commercial |
$1,377.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cofinity Advantage |
$867.30
|
| Rate for Payer: Cofinity Commercial |
$1,065.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$1,115.10
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.15
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.25
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$1,053.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$780.57
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>
|
Professional
|
Both
|
$1,239.00
|
|
|
Service Code
|
HCPCS 22901
|
| Hospital Charge Code |
22901
|
| Min. Negotiated Rate |
$409.17 |
| Max. Negotiated Rate |
$1,189.10 |
| Rate for Payer: Healthscope Commercial |
$1,169.72
|
| Rate for Payer: Aetna Commercial |
$847.26
|
| Rate for Payer: Aetna Medicare |
$657.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.48
|
| Rate for Payer: BCBS Complete |
$429.63
|
| Rate for Payer: BCBS MAPPO |
$632.28
|
| Rate for Payer: BCN Commercial |
$1,011.40
|
| Rate for Payer: BCN Medicare Advantage |
$632.28
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cash Price |
$991.20
|
| Rate for Payer: Cofinity Commercial |
$910.48
|
| Rate for Payer: Cofinity Commercial |
$847.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.28
|
| Rate for Payer: Healthscope Commercial |
$1,011.65
|
| Rate for Payer: Mclaren Medicaid |
$409.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$663.89
|
| Rate for Payer: Meridian Medicaid |
$429.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$695.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,189.10
|
| Rate for Payer: Nomi Health Commercial |
$758.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$929.25
|
| Rate for Payer: PACE SWMI |
$632.28
|
| Rate for Payer: PHP Medicare Advantage |
$632.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,081.16
|
| Rate for Payer: Priority Health Medicare |
$632.28
|
| Rate for Payer: Priority Health SBD |
$1,081.16
|
| Rate for Payer: Priority Health Tiered Network |
$1,081.16
|
| Rate for Payer: Railroad Medicare Medicare |
$632.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,178.07
|
| Rate for Payer: UHC Core |
$1,178.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$632.28
|
| Rate for Payer: UHC Exchange |
$1,178.07
|
| Rate for Payer: UHC Medicaid |
$409.17
|
| Rate for Payer: UHCCP Medicaid |
$409.17
|
|
|
PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
CPT 22903
|
| Hospital Charge Code |
22903
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$463.05 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Commercial |
$624.75
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,946.86
|
| Rate for Payer: BCN Commercial |
$1,946.86
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cofinity Advantage |
$514.50
|
| Rate for Payer: Cofinity Commercial |
$632.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$661.50
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.75
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.25
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$624.75
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$463.05
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
CPT 22903
|
| Hospital Charge Code |
22903
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$463.05 |
| Max. Negotiated Rate |
$661.50 |
| Rate for Payer: Aetna Commercial |
$624.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.75
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cofinity Advantage |
$514.50
|
| Rate for Payer: Cofinity Commercial |
$632.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.00
|
| Rate for Payer: Healthscope Commercial |
$661.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.25
|
| Rate for Payer: PHP Commercial |
$624.75
|
| Rate for Payer: Priority Health SBD |
$463.05
|
|
